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CITY OF CUPERTINO
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BUi'LDING DIVISION PERMIT
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BUILDING ADDRESS:
JOSHUA FREDERICKS
PERMrr NOO 6070063
10395 WUNDERLICH DR
OWNER'S NAME:
PERMIT ISSUE DATE
JOSHUA FREDERICKS
07/12/2006
NE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
of Chapter 9 (commencing
bereby affirm that 1 am licensed under prd idem me
with Section 7") of Division 3 dfthe Business and Professions Code, and my license is
infull force and er LTEMPORARY
s�F L"? °'s'
POWER POLE
License Cl Lk. a Q
Dam — — contracts,
PETE HERRERA CONSTRUCTION PAID BL 7/12/06
ARCHITECI'S DECLARATION
1 understand my plans shall W used as public meet&
Licensed Pmfcssimul
OWNER -BUILDER DECLARATION
I hereby affirm Nat I am exempt from the Ca.0 mars License Law for the
roilnwing reason. (Section 7031.5. Business and Pr.feasiom Cc&: Any city or county
which requires a Permit to construct, alter, improve, demolish, or repair any structure
! prior to its issuance. also requires the applicant for such Permit m Bic a signed statement
is Teemed the Contracars lx<ns< Law (Charter 9
Sq. Ft. Floor Area
Valuatio$389
that he pursuant to pnevlsiom of the
(commencing with Section 7") of Division S of the Businus and Pro(osinns CMc) or
that he a exempt therefrom and the basis for On alleged. My violation or
qpN Number
Occupancy Type
Section 7031.5 by airy applicant for a permit aubjecu one applicant to is civil pmrally of
not more than Ew hundred dollars (55007.
3 7 516029.00
0 1, ss owner of the pmpeny, m my employers with wages» dair3ole companadon.
Required Inspe
will do the work. and Ne structure u nminanded or offered forsale (Sec. 7044, Business
and Profeadost Code: The Contractors License law does act pply m an owner or
ons
Property who builds or impravn thereon, and whodoe.mchum le himself or through his
own employees, provided that such impmaemenu art net imended oroReae l torsade, if.
however, the building or improvement Is sold within one year of completion, the owner -
ve for puoa of
builer will hattheWWooden of proving dot he aid not Wild or improg
d
sak.I. w
J
0 I, as owner of the Property, am exclusively contracting with liavce
ed nuactors to
44
emrinuct the project (See. 70, Business Proposal... Code:) The Comerium's Li
come Law jou not apply in an owmr of property who Wild%or improves thermen, and ,
5/p
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
(� /
License Law.
v/V_
O lamexemplunder a .B&PCrorthumswn
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby of iirn under penalty of perjury ata of the fallowing declamtimu:
I hsw and will maintain a CeruOoa of Comical to self-imure for Workers Compcm
sarion, as provided for by Section 3700 of the Labor Code. for the perfarmance of the
work for which this permit is issued.
0 I haw and will maintain Workers Compensation Insurance, as required by Sectio.
37W of the labor Co ic, for the performance .(the work for which this permit is issued.
My Workers Compensation huuunce carrier and Polity number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Mis mcd.n need not W completed if Oa permit is fmone hundred di IS 100)
or less)
I certify that in Oc performance of the work fes which this Permit u issued. 1 shall not
employ my peraa. 1. Ny mamaI %. as to become subject to the W.rtors' L'mnpecamen
Laws of California. Dow
Applicant
NOTICE TO APPLICANT. If, after making this Certificate of Eacmption, you should
WCome subject In the Worker9 Compensation provisions of the Labor Cede. you most
forthwith comply with such provisions or this permit shall he deemed mokcd.
1
CONSTRUCTION LENDING AGENCY
I hereby affirm that dart is a construction lending agency for Oc performance or
Oc work fur which this permit is issued (Sec. 3097, Civ. C7
lenders Name
Lenders Address
1 1 certify that I haw read this application and sus Nat Inc above information is
Correct. I ague m comply with 211 city and county ordinances and sus laws relating in
Wilding Cmsr ioo. and hereby authomc represenutiws or this city to enter upon the
1 ahove mentioned for inspection purowhich
(We) agree to saw, indemnify and keep harmless the City of Cupcnin. against
dgmemopcny ms.
j r4mit. may in any way aceroc vgainn said City
incoiu mmesm of tis. re of this
APLICA_nce of the gramme of this pewit.
APPLICA DERSTANDS AND WILL COMPLY WITH ALL NON -POINT
EGTIONS.
Issued by: Date
_IXASOUR
2 %—/2
Re -roofs
Sig... of ApplicanuConuvcwr Data
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will da applicant or room building mcup mastere orhandle harandous material
as deftned by To Cupertino Municipal Code. Chapter 9.11. and Inc Health and Safety
Code.section 15531(.)?
Dyes,
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant tax equipment or dcvi os which
If a roof is installed without first obtaining an inspection, I agree to remove
it haraNnus air commuron as defined by the Bay Area Air Quality Management
allnew materials for inspection.
District?
DYa
1 hive ocaJ the hvaNu%smaterials re puircmenu under Cbapter6.95 ofthe Califor-
niaHcalth& Sarcty Codes Sectio. 15505.15533 and 25534.1 undcrsmnd thmifthe Wilding
does met currently haw a a.anl Inas it u my respomibility to mealy the occupant of the
mq men hich must be met prior m issuarae of a CcNficaa of Occupane .
�
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner ormilmn.edaget( D,m
r
an of
OUPEkTINO
u
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
/C35)� fie, w�z:n
PERMIT #
C-CZ 00E -C)
OWNER'S NAME:
PHONE # C /-G G
GENERAL CONTRACTOR
772--9(:;,3
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
-7--12-cC
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Contractor Signature
-7--12-cC
Date
CITY OF CUPERTINO
am 1 of 1 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 37516029.00
DATE ISSUED.......: 07/12/2006
RECEIPT #.........: 35218
REFERENCE ID # ...: 06070063
SITE ADDRESS .....: 10395 WUNDERLICH DR
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OWNER ............: JOSHUA FREDERICKS
ADDRESS ..........:
CITY/STATE/ZIP .... ,
RECEIVED FROM ....: PETER HERRERA
CONTRACTOR .......: LIC # *OWNER*
COMPANY ..........: JOSHUA FREDERICKS
ADDRESS ..........:
CITY/STATE/ZIP .... ,
TELEPHONE ........:
OPERATOR: amyw
COPY # : 2
•FEE
ID UNIT
-----------------------
QUANTITY
----------
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
BTEMP FLAT RATE
1.00
--------------------
62.10
0.00
--------------------
62.10
0.00
BUSLIC FLAT RATE
1.00
105.00
0.00
105.00
0.00
EPERMITFEE FLAT RATE
1.00
.38.37
0.00
38.37
0.00
TOTAL PERMIT
---------- ----------
205.47
0.00
---------- ----------
205.47
0.00
METHOD OF PAYMENT
-----------------
AMOUNT
NUMBER
------------
OTHER
205.47
------------------
VISA
TOTAL RECEIPT
205.47
VOICE ID DESCRIPTION
VOICE
ID
DESCRIPTION
103 UFER
304
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CITY OF
•CUPEkTINO
CITY OF CUPERTINO
TEMP POWER.
PERMIT APPLICATION FORM
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APN # 3�� ^ � � J OZ�
Date:oco
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Building Address:
EPERMITFEE
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ELECTRICAL
Owner's Name:
Phone #:
-
QLqtractor: Phone:
Li ease #:
LIo
L
Contact: l Phone:l
Cupertino Business License #:
Building Permit Info:
Elect Y
Job Description: _
Residential Commercial ❑
Cost of Project
•
Qty. if
Applicable Fee ID
Fee Description
Fee Grou
BTEMP
Temporary Power
ELECTRICAL
EPERMITFEE
Elect. Permit Issuance
ELECTRICAL
BUSLIC
Business License
BUILDING
0